Wang Anxin, Li Haibin, Yuan Jinhuan, Zuo Yingting, Zhang Yijun, Chen Shouhua, Wu Shouling, Wang Yongjun
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
J Stroke. 2020 Jan;22(1):119-129. doi: 10.5853/jos.2019.02075. Epub 2020 Jan 31.
Previous studies suggested increased visit-to-visit variability of total cholesterol (TC) is associated with stroke. This study aimed to investigate the associations of various lipids measurements variability and the risk of stroke and stroke type (ischemic and hemorrhagic stroke).
Fifty-one thousand six hundred twenty participants in the Kailuan Study without history of myocardial infarction, stroke, and cancer who underwent three health examinations during 2006 to 2010 were followed for incident stroke. Variability in TC, triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) measurements were measured using the coefficient of variation (CV), standard deviation (SD), variability independent of the mean (VIM), and average real variability (ARV).
During a median of 6.04 years of follow-up, 1,189 incident stroke (1,036 ischemic and 160 hemorrhagic stroke) occurred. In the multivariable-adjusted model, the hazard ratio (HR) comparing participants in the highest versus lowest quartile of CV of HDL-C were 1.21 (95% confidence interval [CI], 1.02 to 1.45; P for trend=0.013) for ischemic stroke. The highest quartile of CV of LDL-C was associated with 2.17-fold risk of hemorrhagic stroke (HR, 2.17; 95% CI, 1.25 to 3.75; P for trend=0.002) compared with the lowest quartile. We did not observe any significant association between TC and triglycerides variability with any of stroke. Consistent.
were obtained when calculating variability index using SD, VIM, or ARV.
These findings suggest the high visit-to-visit HDL-C and LDL-C variability were associated with an increased incidence of ischemic and hemorrhagic stroke, respectively.
既往研究表明，总胆固醇（TC）就诊间变异性增加与卒中相关。本研究旨在探讨各种血脂测量值变异性与卒中风险及卒中类型（缺血性和出血性卒中）之间的关联。
对开滦研究中51620名无心肌梗死、卒中和癌症病史且在2006年至2010年期间接受了三次健康检查的参与者进行随访，观察新发卒中情况。使用变异系数（CV）、标准差（SD）、独立于均值的变异性（VIM）和平均实际变异性（ARV）来测量TC、甘油三酯、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）测量值的变异性。
在中位随访6.04年期间，发生了1189例新发卒中（1036例缺血性卒中和160例出血性卒中）。在多变量调整模型中，HDL-C的CV最高四分位数与最低四分位数的参与者相比，缺血性卒中的风险比（HR）为1.21（95%置信区间[CI]，1.02至1.45；趋势P=0.013）。与最低四分位数相比，LDL-C的CV最高四分位数与出血性卒中风险增加2.17倍相关（HR，2.17；95%CI，1.25至3.75；趋势P=0.0）。我们未观察到TC和甘油三酯变异性与任何卒中类型之间存在显著关联。使用SD、VIM或ARV计算变异性指数时，结果一致。
这些发现表明，HDL-C和LDL-C的就诊间高变异性分别与缺血性卒中和出血性卒中的发病率增加相关。
